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Aim: In our study, we aimed to investigate the effect of BMI on surgical treatments and general outcomes, as well as on the severity of the injury caused by the sharp object. From an anatomical point of view, increased body mass index (BMI) is expected to have a protective effect in limiting organ damage in the case of sharp object injuries. Material and Methods: Data of the patients with penetrating abdominal injuries who applied to the emergency service of the University between January 2015 and January 2020 were analyzed retrospectively. Patients’ ages, genders, body mass indexes (BMIs), needs for surgical intervention, injury severity scores (ISS) and mortality were evaluated. Patients were divided into 2 groups: obese patients (BMI>30; Group1) and non-obese patients (BMI30; Group2). Results: Seventy-eight patients whose data were available were included in the study. Thirty-three of the patients were determined to be obese (Group1) while 45 were determined to be non-obese (Group2). The mean age of the patients in group1 was significantly higher than the patients in group 2 (p=0.011). The mean ISS of the patients in group 1 was 11.03±8.24 while it was 16.93±13.68 in group 2. The ISS was significantly higher in group2 (p=0.031). Alcohol intoxication levels of the patients in Group 2 were significantly higher than Group 1 (p=0.006). A statistically significant difference was not present between the groups in terms of number of past surgical interventions (p=0.627); however, it was determined that 57% of the surgical interventions in Group 1 were performed for diagnostic purposes and that no pathologies were detected in 45% thereof. Discussion: As a result, increased BMI is associated with lower injury severity scores and decreased need for operation in sharp object injuries. Slim patients are more likely to need surgery and be severely injured.

Aim: the purpose of this study is to determine the prognostic value of the preoperative Neutrophil-to-Lymphocyte ratio (NLR) in patients who underwent curative surgical treatment for hepatocellular carcinoma (HCC). Materials and Methods: Patients who underwent curative resection for HCC between 2004 and 2015 were included in the study. Patients were divided into two groups based on the cut-off value: Group 1 (NLR low) and Group 2 (NLR elevated). Demographics and clinical characteristics, tumor characteristics, and mean survival of patients were compared between the groups. Results: 41 patients were included in our study and Group 1 (NLR low) consisted of (n:11) patients; Group 2 (NLR elevated) consisted of (n:30) patients based on a cut-off value of 2.43. The number of males was higher in both groups (90.9% vs 90%, p:0.712). The Child-Plug class A was the most common one in both groups (81.8%vs76.7%, p:0.680). HBV infection was the most common etiological cause (81.8% vs 53.3%, p:0.344). Lesions were predominantly located in the right lobe (63.6% vs 66.7%, p:0.568). The total tumor diameter was similar (6.56 cm vs 8.69 cm, p:0.258). In the multivariate analysis for survival, tumor diameter greater than 5 cm (HR 1.412 95% - Cl0.345-5.780, p:0.018) and NLR higher than 2.43 (HR 0.100 95% -Cl 0.011-0.882, p:0.038) were independent risk factors. Overall survival time was found to be lower in Group 2 compared to Group 1 (171 vs 106 months p:0.033). Disease-free survival rates were similar in the groups (37 vs 43 months, p:0.485). Conclusion: Although the elevated NLR level was found to be a risk factor for decreased overall survival in our study, this was not related to clinicopathological variables.

Aim: In this study, we aimed to investigate the factors related to postoperative mortality after pancreatoduodenectomy in our clinic. Materials and Methods: Patients who underwent pancreatoduodenectomy due to a periampullary region tumor between 2010 and 2019 were included in the study. Mortality that occurred within 30 days after PD was defined as postoperative mortality and groups were formed according to this definition Group 1(Postoperative Mortality) and Group 2(No mortality). The demographic and clinical features, laboratory parameters, and tumor features of the patients were compared between the groups. Risk factors for mortality were analyzed by univariate analysis and multivariate logistic regression analysis. Results: 155 patients participated in our study. We found our postoperative mortality rate as 11.6%. Accordingly, Group 1 consisted of 18 and Group 2 consisted of 137 patients. The sex was similar (p: 0.235). The average age was higher in Group 1 than 2 (71.2 vs 63.7, p:0.013). Tumor localizations were similar in groups (p:0.275). Lymph node positivity was similar in the groups (50% vs 41.6%, p:0.333). The pancreatic fistula was higher in Group 1, but not statistically significant (33% vs 18.2%, p:0.119). Preoperative white blood cell count (9490 mm3 vs 8050 mm3) and neutrophil count (6898 mm3 vs5442 mm3) were higher in Group 1. In multivariate analysis, no parameters were single-handedly risk factors. Conclusion: No factor was found to be effective alone in the development of mortality after pancreaticoduodenectomy. We think that postoperative mortality may decrease by revealing the factors in the preoperative, intraoperative and postoperative periods.

Aim: Although many studies report risk factors for anastomotic leakage after gastrectomy for gastric cancer (GC), there are conflicting results in the literature. In this study, we aimed to identify the risk factors associated with anastomotic leakage after gastrectomy. Material and Methods: Patients who underwent total gastrectomy for gastric cancer in a single center between September 2015 and September 2018 were evaluated retrospectively. The relationship between anastomotic leakage and clinical variables, tumor characteristics and intraoperative characteristics of 18 parameters were analyzed. The relationship between anastomotic leakage and survival was evaluated.Results: A total of 102 patients were included in the study. Anastomotic leakage rate was 9.81% (10/102). A significant relationship was not determined between anastomotic leakage and age >60 (p:0.232), diabetes mellitus (p:0.334), ASA score >3 (p:0.587), albumin 300 (p:0.582), and operation duration >300 min (p:0.176). Multivariate regression analysis, showed female sex (p: 0.05), body mass index (BMI) >30 (p:0.024) and tumor localization (p:0.005) are independent risk factors for anastomotic leakage. There was a significant difference in mean survival between patients with and without anastomotic leakage (13.9 vs 34.9 months, p: 0.006). Conclusion: Anastomotic leakage was associated with female sex, obesity, and tumor location. We also found that anastomotic leakage adversely affects long-term survival. Detecting risk factors after gastrectomy guides us in the management of patients at the risk for anastomotic leakage.

Aim: Cholangiocellular carcinomas are rare bile duct tumors. They are categorized as intrahepatic(iCCA), perihilar(pCCA) or distal(dCCA) cholangiocarcinomas according to their anatomical location. In this study, we aimed to present our clinical experience in patients with cholangiocellular carcinoma. Material and Methods: Patients who underwent curative surgery with the diagnosis of cholangiocellular carcinoma between 2010 and 2019 were retrospectively reviewed. Demographic and clinical characteristics, surgical procedures, tumor characteristics, short- and long-term results and survival of the patients were analyzed.Results: Twentynine patients were included in the study. The mean age of the patients was 63.3(±10.8) years, and 52% of the patients were older than 65 years. Male sex was 79.3%. Percutaneous biliary drainage was performed in 52% of the patients before the operation. Tumor localizations were distal (dCCA) in 12 (41.4%) patients, perihilar (pCCA) in 11 (38%) patients, and intrahepatic (iCCA) in 6 (20.6%) patients. Only biliary resection was performed in 69%, hepatic + biliary resection in 27.6%, and only hepatic resection in 3.4% of the patients. The mean tumor size was 3.08 cm (±1.91), tumor stage was commonly stage II (58.6%) and postoperative complication was seen in 13.8% of the patients. Ninety-day unplanned readmission was observed in 31.3%, postoperative mortality in 6.9%, and recurrence during postoperative follow-up in 24.2% of the patients. The mean survival time was 22.82(±13.72) months. Conclusion: The type of surgical approach to be performed in cholangiocellular carcinoma is related to the localization of the tumor. With the right patient selection, curative surgical treatment can be performed at low morbidity and mortality rates.

Aim: In this study, we aimed to identify the risk factors associated with postoperative mortality after gastrectomy.Surgical resection is the only potentially curative method for gastric cancer and is associated with severe morbidity and mortality. Material and Methods: Patients who underwent gastrectomy for gastric cancer in a single center between September 2015 and September 2018 were evaluated retrospectively. The relationship between postoperative mortality and clinical variables of the patients, tumor characteristics and 10 variables related to intraoperative characteristics were analyzed.Results: 133 patients were included in our study. Postoperative mortality occurred in 10 patients. Our postoperative mortality rate was 7.5%. Male sex (HR = 0.664, 95% CI =0.460–0.961, p=0.030), tumor localization (linitis plastica (HR = 3.594, 95% CI =1.375–9.390, p=0.009), tumor stage 3C (HR =1.713, 95% CI =0.906–3.239, p=0.0032) total gastrectomy (HR = 1.918 95% CI =1.042–3.532, p=0.036), conventional (open) surgery (HR = 2.807 95% CI =1.546–5.096, p= 0.001), operation duration >240 min (HR = 1.758, 95 % CI =1.064–2.906, p= 0.028), was independently associated with an increased risk of postoperative mortality. Age >60 (p=0.463), body mass index (p=0.414), ASA score >3 p=0.862, intraoperative blood loss >300 (p=0.083) and additional organ resection (p=0.649) were not independent risk factors for mortality.Conclusion: Anastomotic leakage was associated with male sex, obesity, and tumor localization. Anastomotic leakage is related with poor survival. Determining the risk factors after gastrectomy guides us in the management of patients at risk for postoperative mortality.

Aim: In this study, we aimed to determine the clinical value and prognostic significance of neutrophil / lymphocyte ratio in predicting pancreatic fistula in patients who underwent pancreatoduodenectomy due to periampullary tumor.Material and Methods: Patients who underwent pancreatoduodenectomy for periampullary tumor between 2010-2019 were included in the study. Group 1 (LowNLR) and Group 2 (HighNLR) were formed. Demographic and clinical characteristics, intraoperative and postoperative outcomes, and mean survival were compared between the groups. The significance of NLR in predicting pancreatic fistula at the cut off value was examined.Results: Patients were divided into two groups according to the 3.15 cut off value. Group 1 consisted of 61 patients and Group 2 consisted of 62 patients. In Group 2, albumin gr/dl value was lower (3.25 vs 3.70, p:000). in Group 2 pancreas tumors were more common (59.7% vs 42.6%, p: 0.041). The number of metastatic lymph nodes was higher in Group 1 (1.21 vs 0.63, p: 0.043), and the postoperative pancreatic fistula rate was similar (14.8% vs 21%, p: 0.254). Postoperative complications were higher in Group 2 (41.9% vs 14.8%, p: 0.032) NLR predicted pancreatic fistula with a sensitivity of 31.8% and specificity of 86.4%. In multivariate analysis, we found NLR to be a risk factor for survival (HR 1.760, 95% CI,1.179-2.627; p:0.006).Conclusion: Patients with a preoperative high NLR have a worse prognosis than patients with low NLR. It cannot be used alone to predict pancreatic fistula. NLR has the potential to be used in the management of patients.

Aim: In this study, we aimed to determine the clinical value of neutrophil / lymphocyte ratio (NLR) in predicting postoperative complications, lymph node positivity and prognosis in patients who underwent curative surgical resection.Material and Methods: Patients who underwent total gastrectomy for gastric adenocarcinoma between 2015 and 2018 were included in the study. Two groups, Group 1 (LowNLR) and Group 2 (HighNLR), were formed. Demographic and clinical characteristics, intraoperative and postoperative outcomes, and mean survival were compared. The value of NLR in predicting lymph node positivity and postoperative complications was evaluated at the cutoff value determined for NLR.Results: Patients were divided into two groups according to the cutoff value of 2.14. Group 1 consisted of 36 patients and Group 2 consisted of 68 patients. Female sex was higher in Group 2 (72% vs 52%) (p:0.41). Postoperative complication rates according to Clavien Dindo classification were similar (p:0.9). The number of dissected positive lymph nodes was higher in Group 2 than in Group 1 (9 vs 6) (p:0.041). Pathological stage (p:0.188), and overall survival (24.61vs21.12,p:0.206) were similar between the groups. We found NLR as a risk factor for survival in multivariate analysis (HR=0.255, 95%CI: 0.024–0.427, p:0.029). If the NLR value was less than 2.14, the patient had According to Clavien Dindo classification Grade 2 and above complications, with a sensitivity of 46.3% and specificity of 76.0%. A positive lymph node was detected with 44.26% sensitivity and 65.12% specificity. Conclusion: Preoperative high NLR is a risk factor for survival in patients with gastric cancer. High NLR is also closely associated with the risk of postoperative complications.

Aim: Primary hyperparathyroidism is a clinical condition caused by excessive parathyroid secretion of the parathyroid glands and related hypercalsemia. Hyperparathyroidism is a common cause of hypercalcemia. In this study, we aimed to present the results of patients operated on due to parathyroidadenoma in our clinic.Material and Methods: IPatients who underwent surgery for parathyroid adenoma in our clinic between January 2007 and January 2019 were included in the study. Clinical characteristics, biochemical data, treatment methods and results of the patients were analyzed retrospectively.Results: 156 patients with a mean age of 50.8 years participated in the study. Female sex was 76.2%. Preoperative calcium level was found as 11.2+1.02 mg/dl, Parathormone level was found as 114.7+109.5 pg / ml. The most common clinical presentation was asymptomatic hypercalcemia (48.7%). While 89.7% of the patients had only parathoridectomy, 3.2% had total thyroidectomy and 7.1% had lobectomy due to associated thyroid pathology (10.3%). Intraoperative rapid parathormone was used in 54.4% of the patients. Frozen examination was performed in all patients. The most common localization was inferior left 39.7%. The most common ectopic localization was intratymic at 2.6%. The mean duration of postoperative hospital stay was 3.81+2.69 days. Three patients (1.9%) had persistent hyperparathyroidism and 6 patients (3.8%) had recurrent hyperparathyroidism. The mean follow-up was 57.2+39.5 months. Conclusion: Proper preoperative evaluation, careful exploration, frozen examination and rapid parathormone test increase the success of parathyroid adenoma surgery.

Aim: In this study, we aimed to compare the results of conventional and laparoscopic adrenalectomy in patients with adrenal masses greater than 6 cm.Material and Methods: Thirty-six patients with tumor size greater than 6 cm who underwent adrenalectomy between January 2011 and January 2018 were included in the study. Patients were divided into two groups as Group 1 conventional and Group 2 Laparoscopic surgery. The two groups were retrospectively compared in terms of age, sex, mass localization, mass size, duration of operation, amount of bleeding, duration of hospitalization, duration of onset of food intake, perioperative mortality, early period complications and re-admission to the hospital within 90 days. P0.05 was considered statistically significant.Results: There were 13 patients in Group 1 and 23 patients in Group 2. There was no statistically significant difference between the groups in terms of age, sex, tumor localization, tumor size, indications for operation, postoperative complications, perioperative mortality and readmission within 90 days. Duration of operation (min), amount of bleeding (ml), duration of oral intake (day) and duration of hospitalization (day) were higher in Group 1 and statistically significant.Conclusion: Laparoscopic adrenalectomy has demonstrated advantages in patients with a mass greater than 6 cm compared to conventional surgery, such as short operation duration, less blood loss, early onset of oral food intake and shorter hospital stay. It can be safely used in patients with a mass larger than 6 cm.

Aim: There is no examination to determine the exact diagnosis of parathyroid cancer before surgery. The aim of this study was to discuss our surgical experience and the intraoperative findings suggestive of cancer, in parathyroid cancers operated with the diagnosis of primary hyperparathyroidism.Material and Methods: Six patients with parathyroid cancer who were operated on between May 2012 and January 2017, in the Department of General Surgery, xxx were included in the study. Age, sex, complaints of the patients, calcium and parathormone values, imaging methods for localization, intraoperative findings from surgical notes were evaluated retrospectively.Results: Of the patients, 4 were females and 2 were males. The mean age was 61.6+7.28 (50-71). While the lesion was spotted incidentally in three patients, swelling in the neck, back and hip pain, pancreatitis were other reasons for admission. The mean calcium levels were 13.05+1.86 (10.5-15.7) mg/dL, mean parathormone values were 937.4+756.9 (370-1814) pg/ml. Ultrasonography (USG) and parathyroid scintigraphy were performed to all patients. Thyroid scintigraphy was additionally performed on one patient for hyperthyroidism and then FNAB was performed. This patient was operated on with suspected thyroid cancer. In intraoperative evaluation, all of the lesions were firm, adherent to the thyroid capsule and surrounding tissues. One patient had inferior laryngeal nerve invasion. In frozen examination, four patients with suspected parathyroid cancer was specified. Three patients had a lobectomy and 2 patients had en bloc lesion resection with total thyroidectomy. Lesion excision was performed in one patient. After final pathology results, re-operation was suggested, however the patient did not accept.Conclusion: The definitive diagnosis in parathyroid cancer is made by postoperative pathological examination. In cases of primary hyperparathyroidism, in case of intravesical invasion of the thyroid capsule and surrounding tissues during intraoperative examination, parathyroid cancer should be suspected. In case of suspicious findings in frozen examination and intraoperative findings, the surgical plan may be changed and the necessity of secondary surgery can be eliminated.Keywords: Parathyroidcarcinoma; thyroidectomy, hypercalcemia.

Aim: Scarce data are available for rectovaginal fistula (RVF) as a serious complication of low anterior resection with a double-stapled anastomosis for rectal cancer. In this study, we aimed to evaluate our surgical management of RVFs formed due to stapler use.Material and Methods: Between 2010 and 2018, patients who developed rectovaginal fistula after the use of circular stapler during rectal surgery were included. Clinic characteristics, type of surgical treatment performed and details of surgery in patients were retrospectively evaluated.Results: Ten patients for whom stapler device was used for rectal cancer surgery and diagnosed with RVF were included in our study. The mean age of the patients was 45.7±11.8 and mean BMI value was 27±2.4. For 9 patients who had primary repair for RVFs, 7 patients experienced recurrence after their first operation. For this subgroup, muscle flap was performed in 3, vaginal mucosa advancement flap 2, sartius flap one, and another primary repair plus fibrin glue application one patient. After the second interventions, two patients were managed with muscle flap creation and primary repair plus fibrin glue was required for one patient, for their recurrence. For patient who had primary repair plus fibrin glue application for her second operation, sigmoid colostomy followed by abdominoperineal resection was required for persisting complaints.Conclusion: The management of postoperative (RVF) after low anterior resection for rectal cancer is difficult and the results are often unsatisfactory. Endoanal mucosal flaps and muscle flaps are the treatment modalities we recommend, especially in patients with recurrence.Keywords: Circular stapler; rectovaginal fistula; rectal cancer.